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Thursday, September 28, 2023

Readers Rail at Social Safety Overpayments and Insurers’ Prior Authorizations

Letters to the Editor is a periodic function. We welcome all feedback and can publish a variety. We edit for size and readability and require full names.

A registered nurse who works in New Jersey’s Matawan-Aberdeen Regional College District reacted on X, previously generally known as Twitter, to KFF Well being Information’ investigative collaboration with Cox Media Group on the federal authorities’s try to claw again cash it has overpaid to Social Safety beneficiaries: “Social Safety Overpays Billions to Individuals, Many on Incapacity. Then It Calls for the Cash Again” (Sept. 15).

Can I simply say to inform of us that they solely have 30 days to pay again any overpayments that they seemingly weren’t even conscious of till they obtained the discover, is loopy!https://t.co/CfaWrd9VVQ

— Sheila Caldwell (@SCaldwell7201) September 17, 2023

— Sheila Caldwell, Aberdeen, New Jersey

A regulation professor on the S.J. Quinney School of Regulation on the College of Utah additionally chimed in on X:

Vital @KFF @KFFHealthNewsexposé on Social Safety making errors and sending individuals ludicrous payments to to recuperate overpayments. One disabled lady bought a invoice for $60,175.90 out of the blue. The company suffers from underfunding/understaffinghttps://t.co/0vNfROIVe9

— Daniel G. Aaron, MD, JD (@MedlawDan) September 18, 2023

— Daniel G. Aaron, Salt Lake Metropolis

For Disgrace, UnitedHealthcare

Thanks for shining a lightweight on probably the most infuriating insurance coverage obstacles in all of medication: prior authorization (“Medical doctors and Sufferers Attempt to Disgrace Insurers On-line to Reverse Prior Authorization Denials,” Aug. 23).

Through the pandemic, many individuals skipped or couldn’t entry routine medical care equivalent to colonoscopies and endoscopies. Analysis has lengthy proven that these companies are underutilized, particularly amongst communities of shade, which is one cause for continued disparities in colorectal most cancers and different gastrointestinal illnesses.

Because the demand for routine diagnostic and surveillance procedures grows, it’s crucial to make sure that sufferers usually are not caught up in bureaucratic pink tape. Sadly, the nation’s largest and most worthwhile insurer, UnitedHealthcare, is slowly, quietly working to broaden prior authorization to those key types of gastrointestinal care.

Whereas UHC publicly pledged to slash prior authorization, we should decide them by their actions, not their phrases. Since UHC made that promise this spring — a transfer welcomed by docs and sufferers throughout the nation — the insurer additionally introduced troubling new prior authorization necessities for colonoscopies and endoscopies for its 27 million industrial beneficiaries. The insurer deliberate to start implementing prior authorization for these important procedures beginning June 1 however quickly halted the plan after main outcry from sufferers and gastroenterologists.

But, the risk lingers. Proper now, UHC is asking docs to take part in a burdensome “Superior Notification program,” which forces physicians to submit every kind of information that the insurer will use to tell its deliberate “Gold Card” prior authorization program in 2024.

Physicians see via this ruse. Whereas UHC claims no sufferers are being denied the colonoscopies and endoscopies that would assist save their lives, the executive burden Superior Notification causes is clogging already backlogged workplaces, particularly small practices. Even worse, the gastroenterological neighborhood fears that thousands and thousands of sufferers could face UHC’s prior authorization necessities in a matter of months — but the insurer has did not coordinate with specialty societies or transparently talk how this system will function or how UHC will guarantee affected person care is just not disrupted.

This situation impacts all of us. If UHC is allowed to disclaim or delay colonoscopies and endoscopies, the place will it finish? Diagnostic mammograms? Pap smears? Lung most cancers screenings? And can different insurers observe go well with with equally oppressive prior authorization insurance policies?

UHC should instantly reverse course on its alarming insurance policies to make sure streamlined entry to care. Within the meantime, gastroenterologists will proceed to carry the road for our sufferers.

— Lawrence Kim, vp of the American Gastroenterological Affiliation, Lone Tree, Colorado

The branding director for Norwood, a well being care staffing and consulting firm in Texas, posted on X that publicly shaming insurers could show a sensible technique.

Good; shameful practices deserve public shaming: Medical doctors and Sufferers Attempt to Disgrace Insurers On-line to Reverse Prior Authorization Denials https://t.co/OvbTUXOkOR through @kffhealthnews

— Brian Murphy (@NorwoodCDI) August 23, 2023

— Brian Murphy, Austin, Texas

Response was additionally strong on Threads:

How New York Is Tackling Tobacco Use Amongst Youths

I simply learn Liz Szabo’s piece on baby nicotine poisonings (“Medical doctors Sound Alarm About Youngster Nicotine Poisoning as Vapes Flood the US Market,” Aug. 3). The reporting illuminated a vital but lesser-known situation relating to the harms of those e-liquids. The response does name for a mixed public well being effort, so I wished to share additional info relating to New York state coverage (talked about within the piece) that has proven to achieve success in lowering the sale and use of vapes and conventional, flamable cigarettes. This policy-level intervention’s outcomes suggest that fewer younger youngsters are being uncovered to/have entry to those merchandise primarily based on decreased charges of smoking and vaping use and initiation amongst older siblings or adults round them. I hope this info proves helpful to your nationwide viewers who could contemplate these insurance policies within the context of their state’s.

The New York State Division of Well being launched three new stories that point out that the present tobacco management insurance policies adopted within the state have helped successfully cut back tobacco use and initiation, together with smoking and vaping. The evidence-based approaches bolstered ongoing decreases in youth vaping charges; between 2018 and 2022, charges declined by about 32%. Youth tobacco use (of any tobacco product) additionally declined by 32%, from 30.6% in 2018 to twenty.8% in 2022. This important decline brings New York nearer to attaining the Prevention Agenda aim of reducing highschool youth tobacco use to 19.7% by 2024.

Whereas that is nice progress, tobacco nonetheless is the No. 1 reason for preventable illness in america — it’s estimated that it kills 480,000 adults within the U.S. yearly — and there are nonetheless points with regulation and an absence of protecting packaging on vapes.

NYC Treats Tobacco works with well being care organizations in New York Metropolis to make sure they successfully display screen and deal with their sufferers for tobacco use.

— Avani B. Ansari, MPH, CHES, venture coordinator for NYC Treats Tobacco, New York Metropolis

A corporation that advocates for insurance policies selling alternatives and wellness for kids posted this on X:

1000’s of youngsters a 12 months are uncovered to the liquid nicotine in e-cigarettes, often known as vapes. For a toddler, even a couple of drops may be deadly. Medical doctors sound alarm about baby nicotine poisoning as vapes flood the US market: https://t.co/3IHV8L1UKX

— KY Youth Advocates (@KYYouth) August 14, 2023

— Kentucky Youth Advocates, Jeffersontown, Kentucky

And a Georgia state consultant shared her two cents on X relating to Liz Szabo’s earlier protection on youth vaping:

Youth vaping is on the rise, with the trade advertising and marketing merchandise blatantly focused to youngsters + teenagers.The unregulated nicotine in e-cigs (⬆️ 76% over 5y) can addict youngsters in simply days.My payments #HR43 and #HB192 intention to check + disincentivize youth vaping.https://t.co/p5NGJd8gAw

— Dr. Michelle Au (@AuforGA) June 27, 2023

— Michelle Au, Johns Creek, Georgia

KFF Well being Information is a nationwide newsroom that produces in-depth journalism about well being points and is without doubt one of the core working packages at KFF—an impartial supply of well being coverage analysis, polling, and journalism. Be taught extra about KFF.


This story may be republished at no cost (particulars).

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